**6. Conclusion**

These are devastating injuries that are daunting; however, after the patient is stabilized and initial first aid is administered, the assessment should provide a checklist of what is damaged, and what is available for reconstruction; this would include what may be "scavenged" from the parts that are not reattachable—such as skin, parts of bone, even tendons nerves and vessels. The most challenging part is for the surgeon to accept that a "normal" hand will not result but we must remember that if almost all is lost, whatever we salvage is a plus point. Having said that, there are some main points to bear in mind—the goal should be the "greatest total benefit for our patient" [45], which may be different in various countries, cultures and beliefs. Clear communication, an idea of what is feasibly possible and the likely end result are some of the factors to bear in mind when discussing options with the patient and their relatives.
